Democratic Northwest. [volume] (Napoleon, Ohio) 1869-1894, 1887-01-13
SURGICAL SKILL.
Three Hours and a Half on the oper.
ating Table.
A Case of Aneurlsm in the Neck in a
MiddIe-Aged Colored Woman.

A Case of Aneurlsm in the Neck in d
Middle-Aged Colored Woman.
NEW YORK, Jan. l.-AmOng the deli
cate operations in surgery there is none
more fascinating than tying arteries.
Even though the ruptured vessel Is not
large, there is a sort of CHASTITY pleasure
enjoyed by the surgeon when he seizes
the bleeding point and watches the
flow of blood stop with the conscious
ness that he has saved life. When
the larger arteries are to be tied, the
element ofdanger enters in large de-
gree, and increases as the arteries to be
tied approach the location of the heart.
This is especially true in the case of
operations for aneurisms in the neck or
chest. No matter how much skill is
shown by the surgeon in tying the
large arteries in the neck, the chances
are not one in hundred that the pa
tient will live. In fact the percentage
of recoveries is so small that surgeons
often refuse to undertake an operation
for aneurism in the neck.
Among this class of operations there
is none more dangerous than the tying
of the subclavian artery. 1t was recent
ly done successfully at the st. Elizabeth
Hospital by DIR. T. W.Keane, a young
surgeon, whose boldnsss and skill are
fast raising him to an elevated position
among the many eminent specialists in
this city.
The patient was a middle-aged color
ed woman. The history of the case
shows that she was struck
A VIOLENT BLOW IN THE NECK
By hammer in the hand of her hus-
band several years ago. There was no
special effect save the pain and the
bruise at the time, but soon afterward
slight swelling appeared on the right
side of her neck. 1t was not trouble
some at first, developing slowly, but no
inconvenience followed until some of
the nerves were affected, and then the
pain was intense. AS the tumor still
increased in size, and the pressure on
the nerves became greater, the woman
suffered the most excruciating agony
all the time, and was frequently thrown
into convulsions.
When admitted to the hospital sew
eral weeks ago
THE DIAMETER OF THE TUMoR
At its widest section was about five
inches. It's nature was readily deter
mined. It's location was over the sub
clavian artery, and every pulsation OF
the heart could be easily detected in
the tumor, which is one of the distin-
gushing characteristics of an aneur-
ism. In fact it had become so far ad-
vanced that it had stretched the skin
to such an extent that the pulsation
was visible to the eye. With the
stethoscope blowing or kissing sound
could be heard with each pulsation as
the blood rushed into the sac from the
artery.
In every aneurism there is a sac,
which is formed by the rupture or di-
lation of an artery and communicates
with the artery. The blood, instead of
flowing naturally through the artery,
empties into the sac. The sac steadily
increases in size in the usual develop
ment of an aneurism until an inflam-
nation is caused in the skin, which
causes it finally to slough, and then
FATAL BLEEDING FOLLOWS,
Either with sudden rush that speedi-
ly ends in death or slow oozing. An
eurisms have been cured by compress
sion of the artery, manipulation and
artificial coagulation, but the usual
remedy is by the use of the ligature,
where the artery is tied between the
aneurism and the heart, and the supply
of blood cut off.
Despite the hazardous nature of the
undertaking, as soon as the precise
location of the aneurism was ascertain
ed, DIR. Keane determined to try the
cure by ligature, this being the only
chance that was left in the advanced
stage of the disease. The patient was
accordingly taken to the operating room
and placed under either. Her head
was turned to the left side, and the
right shoulder was depressed as much
as possible. While tension was put
on the flesh an incision was made
about four inches in length, just above
and along the line of the clavicle or
collar-bone, running from the edge of
the sterno-mastold muscle to the trap
eZlus muscle to the back. The incision
was extended downward through the
fat and tissue with the greatest care un-
til the external
JUGULAR VEIN CECAME vISABLE.
A blunt hook was passed around the
vein and it was dissected loose from its
attachments and drawn to the side.
The mastold muscle where it unites
with the collar-bone was found to be
so broad as to interfere with the eXplor-
. alton, and it was detached from the
bone and gently turned loose and raised
upward.
The knife was then laid away, as it
was not deemed safe to use it further,
because the slightest slip might cause a
fatal injury. Small probes, hooks and
directors were used to break up the tis-
sue into small sections, and this deli
cate work was continued until the
Omophyoid muscle was seen. IL was
somewhat out of its usual position.
Directly beneath it was the pulsating
subcavian. 1t could be felt, but not
seen. The lower end of the omophyoid
muscle was raised with blunt hook
and drawn backward. Several veins
which had been severed bled profusely,
and the operation had to be stopped
until
THE HEMORRHAGE
Was checked. When this had been
done, the surgeon introduced his fore
finger into the wound to locate the an